Avram Denburg (health policy, McMaster University) is a paediatric oncologist working to construct a more coherent decision-making framework—informed by public values—for funding new cancer drugs for children in Canada.

Doctoral research

The Politics of Child Health Technologies: Social Values and Public Policy on Cancer Drug Funding Decisions for Children in Canada

Children have suffered historical neglect in drug research and development, owing to a confluence of political, economic and regulatory factors. Recent efforts to redress this circumstance have helped reform the global landscape of drug development to incorporate the unique needs of children into research and regulatory paradigms. One area of persistent neglect is public policy on funding for pediatric medicines. As the pace of technological innovation has increased, challenges have surfaced in the evaluation of novel therapies for public coverage. Health technology assessment (HTA) frameworks appraise the value of technologies - be they drugs, devices, procedures or services - to inform policy decision-making and resource allocation amongst alternative technologies within publicly funded health systems. The prevailing principles and metrics by which HT A is conducted were designed with adult health conditions and treatments in mind. The evidentiary and normative dimensions of HTA frameworks may have unique repercussions for drug policy and coverage decisions in children, but their relevance to child health has received almost no critical scrutiny in either academic or policy circles. His research will probe the complexities and potential shortcomings of traditional HTA methods as applied to children, with a specific focus on cancer drug funding processes and decisions in Canada. It will map and critically analyze this policy landscape, through study of the relationships between evidence, economics and social values in drug policy for children. The project will yield specific knowledge of policy on pediatric cancer drug funding in Canada and conceptual insight into the social values that inform child HTA.

Methodological approach

A mixed methods study of social values in child HTA, through substantive case studies of recent paediatric cancer drug funding decisions in Canada. A critical review of the ethical dimensions of child HTA will frame the empirical phases of research. Grounded theory analysis of qualitative interviews with key stakeholders involved in or impacted by HT A for child cancer drugs in Canada will inform the design and conduct of a population-based survey on social values for child HTA.

Avram Denburg is a paediatric oncologist and a Canadian Institutes of Health Research doctoral fellow in health policy at McMaster University. His clinical, research, and advocacy pursuits are impelled by a recognition of, and a desire to attenuate, global and local disparities in child health and protection.

Avram holds an undergraduate degree in history, philosophy, and political science from the University of Toronto. He completed medical school at McMaster University, after which he undertook a post-graduate medical residency in paediatrics and a clinical fellowship in haematology/oncology at the University of Toronto and the Hospital for Sick Children. Avram is a fellow of the Royal College of Physicians and Surgeons of Canada and of the American Academy of Pediatrics. As a Commonwealth scholar, he obtained a master’s of science in health policy, planning, and financing from the London School of Economics and the London School of Hygiene and Tropical Medicine. He trained at Harvard University as a fellow of the National Institutes of Health-funded Pediatric Scientist Development Program.

Avram's research explores the intersection of ethics and child health policy. In the past, his work has focused on issues of access to essential medicines for children, the social determinants of child health and development, international health research ethics, and the ethics of priority-setting in health systems. His current research examines normative and methodological issues in the assessment of child health technologies, especially pharmaceutical policy and drug coverage decisions for children.

Avram is a board member of Canadian Doctors for Medicare, the chair of the Essential Medicines Working Group for the International Society of Pediatric Oncology, and the co-chair of the Global Health Ethics Collaborative at the University of Toronto's Joint Centre for Bioethics. While at Harvard, he chaired the Childhood Cancer Committee of the Global Task Force for Expanded Access to Cancer Care and Control, an international advocacy organization aimed at reducing global disparities in cancer outcomes. As a pediatrician, Avram has worked with and learned from a diversity of marginalized children and youth, including villagers in Zimbabwe and Tanzania, Maori adolescents in New Zealand, First Nations youth in Northern Canada, Karen refugee children in Toronto, and children with cancer in the southern Philippines. Avram co-founded a paediatric clinic for refugee and immigrant children in Toronto that provides care for vulnerable children who lack access to publicly insured health services.

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